Can a relatively low-tax country run a high-quality, taxpayer-funded health service that is free to all? Britain’s National Health Service suggests the answer is no.
The NHS is good at some things but bad, bordering on disastrous, at others. Its great virtue is truly universal coverage, no questions asked — and by international standards, the system is also cheap to run. As a result, though, it is perpetually short of money, and the service is erratic.
Today the NHS is yet again dealing with a financial crisis and a surge of complaints about standards.
Prime Minister Theresa May has had to apologise to patients for a winter breakdown that has resulted in operations being postponed and emergency-room waiting times rising well over the promised four-hour maximum. That comes a year after the British Red Cross declared the service was on the verge of a “humanitarian crisis”.
The NHS’s problems — too many patients and not enough staff — are not seasonal. Britain’s population is growing and getting older, and as medicine advances, treatments become more sophisticated and expensive.
Many years of meagre funding are taking their toll. In relation to population, Britain has fewer doctors, CT scanners and MRI units per capita than most other EU countries, and ranks towards the bottom of the league on infant mortality. Other universal-coverage systems score better on avoidable deaths, cancer survival, innovation, consistency of service and other measures.
Long waiting times for some non-urgent treatments are leading more patients, many suffering chronic pain, to tap savings or borrow for private treatment.
Granted, more money by itself will not cure the system. One former head of the Treasury called the NHS a “bottomless pit”.
Even so, bearing in mind how little the NHS costs, more money is surely part of the answer, as long as it is combined with further efforts to run the system more efficiently.
For instance, social care for the elderly and other groups has not kept pace with what is required, placing an added burden on more costly medical professionals.
Fixing that kind of misallocation would improve the system’s value for money.
The public’s devotion to the principle underlying the NHS is undiminished: the British see healthcare as a right. Increasingly, though, they are also demanding higher standards of care, and those come at a price. Taxpayers must either dig deeper to maintain the existing service — deeper still to improve it — or else accept that the NHS will continue to disappoint.