Is NHS Broken?

The editors of the Wall Street Journal say that Trump is right, British National Health is broken:

The NHS is in the middle of its annual winter crisis—wherein central planners forget which season follows spring, summer and autumn and must reschedule surgeries and leave the ill in hospital hallways because the health service hasn’t prepared for its busiest time. Hospitals are running at 95% occupancy, and patients are waiting longer for urgent treatment. Only 85% of emergency-room patients were seen within four hours of arrival in December, the lowest share on record and well short of the NHS goal of 95%. January was probably worse.

The pressure for more spending is constant but it must compete against other demands in a country with already high tax rates. Spending on the NHS has increased by 1.3% annually in inflation-adjusted terms since 2010. That’s faster than British living standards are growing as wage increases have lagged inflation since the 2008 financial panic.

The default is to ration care. Last year the NHS in England abandoned its decade-old pledge to deliver non-emergency surgeries such as hip replacements and cataract operations within 18 weeks of referral by a general practitioner. This is supposed to free up hospital space to improve abysmal emergency-room performance. British patients also wait longer than most other Europeans to see primary physicians and get tests such as CT scans.

Treatment for British patients diagnosed with common cancers such as lung, breast and prostate lags most other developed countries. Of women diagnosed with breast cancer, 90.2% of those treated in America now survive for at least five years, according to a study published last month in The Lancet. The five-year survival rate is 85.6% in Britain. In America the five-year survival rate for prostate cancer is 97.4%, compared with 88.7% in the U.K. That translates to thousands of “excess” deaths—people who would have survived in a health system other than the NHS.

This sure sounds like a health system that’s “broke and not working.” Britain will need to spend more money on health care as its population ages and life spans lengthen. A report last month from the government’s Office for Budget Responsibility estimates health spending will increase to 12.6% of GDP by 2067 from around 7% today. But much of that will be wasted in an unreformed NHS.

To place that rate of increasing costs into perspective Britain’s annual inflation rate, like ours, has varied from about 2% to about 3%. To say that health care has increased at 1.3% means that it has increasd from twice as fast as other costs to about half again as fast. Since health care only comprises about 10% of the British economy rather than the 17% it does here, that means that health care isn’t presenting the entirety of the increases in the cost of living but it’s a lot.

I don’t know whether NHS is broken or not. Here’s James Ball at the Guardian:

The first thing that Americans should know about the National Health Service is that it’s free at the point of use to anyone who needs it. You don’t have to fill out much paperwork, and you get no bills, whether you go to see your family doctor, or go to hospital. No one in the UK goes bankrupt through medical costs, no one needs to delay medical treatment until they can afford it, and virtually no one is uninsured.

The healthcare it provides is … OK. This is a controversial assessment in the UK, as the NHS often ranks as the most popular institution in the UK, more popular than the military and even the royal family, with nurses and doctors being the two most trusted professions in the country.

Despite its popularity, though, the NHS performs roughly mid-table in terms of bang for its buck: some countries spending roughly the same on health get considerably better outcomes, others get much worse. One country the UK outstrips by a huge amount, though, is the US.

According to data gathered by the OECD, the average UK spend per head on healthcare is $4,192 (£2,989) – and it has a life expectancy of 81.6 years. The US spends more than twice this amount, $9,892 – far more than any other country in the world – and yet life expectancy is far lower.

What I can say with confidence is that even a fully nationalized health care system like Britain’s is not a panacea. Costs are still increasing faster than the British can afford. I can’t say this for sure but I think the basic problem is that it’s very hard to deny people the health care they need or want or to cut salaries in health care to the point where you can’t get the professionals you need. So costs increase beyond the ability to pay.