Beware universal health care

April 6, 2009

In the past five years there has been much discussion about the United States' health care system. This discussion will continue and significant changes will occur with the new administration.

I have been reviewing some history concerning the British Health Care Service. Some of this information was in an article by Melville P. Roberts, emeritus professor of surgery at the University of Connecticut School of Medicine.

The British National Health Service is now more than 60 years old and is a wholly state-funded-and-managed organization. It is the largest employer in Europe and one of the largest employers in the world. The British National Health Service was established in November 1946. A government report written in 1942 was aimed at solving these five problems—wants, disease, ignorance, squalor and idleness. This report began the template for the British post-World War II welfare state.

Aneurin Bevan, as secretary of health, was responsible for the structure of the NHS. Bevan, a Marxist and Churchill's chief critic, was elected to Parliament in 1929 at age 34. In 1945, the Labour Party came to power and Bevan was appointed secretary of health. Bevan greatly admired Soviet Russia, which he had visited twice, and based the structure of the NHS on the Russian system.

The service was to be totally government-funded, managed and free at the point of delivery. Coverage was universal. The service was created in 1946, but the medical profession opposed it and refused to cooperate. Amendments were made and Bevan stated that he secured the compromise by "stuffing the doctors' mouths with gold."

Every administration since that time has tried to reorganize the NHS. This includes Margaret Thatcher's Conservative Party and Tony Blair's Labour Party. There was a reduction in the hospital waiting list from 1.26 million to just more than 500,000 between 1998 and 2008. NHS funding has increased from 3.5 percent of GDP to 7.8 percent. The availability of medical, dental, nursing and technical services have also increased.

Unfortunately, there was also an increase in administrative and clerical staff, from 29,000 in 1951 to 280,700 in 2005. Spending has tripled over the past decade to 100 billion pounds. Nevertheless, complaints continue. Open, mixed-gender wards still exist in hospitals, and 2 million patients each year report not being treated with respect and dignity. Problems with hospital hygiene have led to hundreds of deaths. Cancer survival rates based upon treatment from time of diagnosis to five years are among the lowest in Europe. Many drugs cannot be prescribed as they have not been approved as being cost-effective.

The NHS seemed a good idea when it was created, but its difficulties serve as an important warning of what can go wrong when government pays for all medical treatment for all citizens. Government micromanagement has resulted in an increasing bureaucracy, unreasonable growing costs and compromised standards of treatment.

Any administration considering a tax-funded universal health care system that is free at the point of delivery would do well to examine the NHS.

Spitzberg is an ophthalmologist at St. Francis Hospital in Mooresville and associate professor of the Indiana University School of Medicine.

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