Younger doctors who are flirting with support of government-run health care should consider some hard facts—including the unfortunate results such control would likely have for patients and doctors themselves. They should also look at the recent raw experience of Britain with a government-controlled health care system.
Recently, Sanders, I-Vt., claimed that his bill would save more than $2 trillion over a 10-year period. According to the Associated Press, however, the senator “mischaracterized” the analysis upon which that estimate was based, a major study of the cost of the Sanders bill by Charles Blahous, a former Medicare trustee, now at the Mercatus Center.
As the Associated Press’ fact check notes, the $2.1 trillion “savings” estimate rests on the implausible assumption—studiously ignored by Sanders and others—that hospitals and staffing levels would remain the same—despite an estimated 40 percent reduction in compensation for medical services.
Such a massive pay cut would guarantee, says Blahous, that doctors and hospitals would get paid for services “substantially below” their costs of providing the services. Thus, he warns, “ … whether providers could sustain such losses and remain in operation, and how those who continue operations would adapt to such dramatic payment reductions, are critically important questions.”
Yes, they are. Blahous’ findings are particularly relevant for young men and women entering medical school. As Kaiser Health News recently reported, a growing contingent of young physicians and medical students favor expanding the power of government officials to control medicine, and thus their professional lives.
After all, most students become doctors more out of a desire to care for patients than to make a lot of money. Sanders’ proposed pay cut, however, would likely price many doctors out of independent practice, as well as decimate larger medical systems—neither of which would benefit patients.
Medicare would ostensibly be the model for Sanders’ national health insurance program. Beyond lower payment levels, Medicare is governed by tens of thousands of pages of rules, regulations, and guidelines.
The transactional or administrative costs that doctors and other medical professionals already incur in compliance with these reams of red tape are real, though they do not show up on Medicare or Medicaid budget documents. That is one reason why Medicare’s official administrative costs are deceptively low; the government shifts a large share of administrative costs onto medical professionals.
By 2030, America faces a physician shortage ranging from roughly 43,000 to 121,000, depending upon the assumptions. The crush of nonclinical administrative duties are today a leading cause of American physician burnout and accelerated retirements.
Ultimately, the Sanders bill, by reducing physician compensation while enlarging the power of Washington’s health care bureaucracy, would only make matters worse.
Young doctors—and anyone else considering government-run health care—should look at the performance of the British National Health Service.
In a candid Oct. 12, 1975 interview with the London Sunday Times, then-Labor Minister David Owen, conceded:
The health service was launched on a fallacy. First, we were going to finance everything, cure the nation and then spending would drop. That fallacy has been exposed. Then there was a period when everybody thought the public could have whatever they needed on the health service- it was just a question of governmental will. Now we recognize that no country, even if they are prepared to pay the taxes, can supply everything.
Today, the British National Health Service is plagued with long wait times, delayed procedures, and an overstressed medical workforce.
A cursory survey of recent British news sources reveals a worrying trend in the delayed delivery and deteriorating quality of National Health Service health care. While British tabloids can be sensational, with bleeding ledes on hospital problems, sober British analysts are concerned.
Last winter, a particularly virulent strain of influenza hit Britain. British hospital wards are often overcrowded, but the crush of flu patients exacerbated the system’s persistent and underlying problems—inadequate staffing and insufficient resources. The British Medical Association’s quarterly survey of physicians found that 82 percent of respondents felt their workplaces were understaffed.
One doctor described the situation this way to the British Medical Association: “I came on to shift yesterday afternoon and there were patients literally everywhere. The corridor into the hospital was so busy we couldn’t have got a cardiac arrest patient through it into the resuscitation room.” He added, “To say staff were at the end of their tethers would be a complete understatement.”
National Health Service morale has been suffering, and British Medical Association surveys show that complaints about resources, understaffing, and perpetual physician vacancies have been constant.
Aggravated by the flu season, and budget constraints, the National Health Service cancelled some 50,000 “non-urgent” surgeries. The problem is that the urgency for a particular patient’s surgery is, or should be, a doctor’s clinical judgment. For example, surgery for a person to repair an abdominal aortic aneurysm (AAA), for instance, may be delayed. But delaying an AAA repair is risking rupture, and patients with a ruptured AAA have a 90 percent mortality rate.
By March 2018, British emergency departments reached new lows, leaving 15.4 percent of patients waiting over four hours before being seen. This was far short of the goal of less than 5 percent of patients forced to wait over four hours.
When considering only major emergency departments, classified as Type 1 in the National Health Service, the rate increased to 23.6 percent of patients waiting longer than four hours to be seen. The British Medical Journal reports that this is the worst performance since 2004, when these metrics were first tracked.
Outside of emergency departments, the number of British patients waiting 18 weeks or more for treatment increased by 35 percent, which was an increase of 128,575 patients from about 362,000 patients in 2017, to over 490,000 patients in 2018.
Additionally, by March 2018, 2,755 patients had waited over a year to be treated, compared to 1,528 patients in 2017. In England, the National Health Service also broke records by canceling over 25,000 surgeries at the last minute in the first quarter of 2018—this was the highest number of last-minute cancellations in 24 years. Remarkably, this was after the British authorities initiated a series of reforms that started in 2016.
The British, of course, are responsible for their system and its results. They will, or will not, undertake reforms to reduce long queues, delayed care, and the consequent harm to British patients.
It is naïve, however, to believe that Americans can avoid similar consequences—annual budget dramas, long waiting times, and scandalous care denials—by giving members of Congress and officials of the federal bureaucracy control over American health care.