What the Experience of the British NHS May Tell Us about America’s Future Under ObamaCare

By Dave Andrusko

Burke J. Balch, J.D.

For many reasons, including the vocal admiration of President Obama’s Medicare/Medicaid Chief David Berwick for the British National Health Services (NHS), skeptics of ObamaCare are watching developments in the NHS for signs of what could happen here, should ObamaCare not be repealed and replaced.

A story that appeared yesterday in BBC News bears out the worst fears of ObamaCare critics. Written by Health correspondent Branwen Jeffreys, “Surgeons raise alarm over waiting” sets off any number of alarms among those who worry ObamaCare will inexorably lead to the kind rationing of medical services, formally or operationally, that the government-run medical system in England is already experiencing.

The primary focus in this story is on hip and knee replacements, but the lessons are more far-reaching.

According to Jeffreys, “Surgeons say patients in some parts of England have spent months waiting in pain because of delayed operations,” a manifestation of what might be labeled a visible waiting period. “Invisible waiting periods” take many forms—“implement[ing] stricter new criteria which have the effect of delaying the point when a patient can be referred for treatment,” Jeffreys writes. “An investigation by the BBC also found evidence [of many] new thresholds being added for hip and knee replacements.”

This is precisely the sort of covert rationing we can expect from the unholy alliance of the “Independent Payment Advisory Board” and the U.S. federal department of health and human services (HHS) if Obamacare is not repealed.  Starting in 2015, the unaccountable group of 18 bureaucrats who will make up the obscurely named board will be directed to develop recommendations to limit what private citizens are allowed to spend on life-saving health care, out of their own funds, so that it is not permitted to keep up with the rate of medical inflation.  These recommendations will be implemented by so-called “quality” and “efficiency” standards the law authorizes HHS to impose on all health care providers–standards like the NHS “stricter new criteria” that delay when patients may be referred for treatment.

U.S. doctors who give their patients treatment that exceeds what the federal “quality” standards permit will not be able to contract with qualified health insurance plans.  As a result, a one-size-fits-all stranglehold will be forced on all patients, regardless of whether they would be willing to pay for more, so as gradually to squeeze out of America’s health care system even enough health care to maintain today’s standards (because it will not be permitted to keep up with medical inflation) – let alone the prospect of progress in medical innovation.

Ironically, despite the rationing horrors of the NHS, if Obamacare remains unrepealed those Americans who can manage to do so may soon be flocking to Great Britain for life-saving treatment they can no longer get here.  That’s because the U.K.’s health care system is a little like the educational system in the U.S.  Here, everyone pays taxes to support the public schools, but parents can still enroll their children in self-supporting parochial and private schools.  In the United Kingdom, everyone pays taxes to support the NHS, but people can instead choose to go to privately paid physicians and hospitals.  Private health insurance is even available for purchase so that the British can get coverage for major medical expenses in the private (nongovernmental) health care system.

But because of the Independent Payment Advisory Board and the HHS “quality” and “efficiency” standards that will be imposed on all U.S. heath care providers, in this country patients will uniformly be subjected to rationing regardless of whether their health care is covered by government progams like Medicare and Medicaid or private health insurance.  Just as Canadians now come to the U.S. to get treatments they are denied in their native land, Americans (and Canadians) may well need to travel to Great Britain to access the unrationed private health care system that exists alongside the rationing-ridden NHS there.

While President Obama and the previous Congress have committed the U.S. to a government-imposed system of uniform standards for what treatment Americans may and may not receive, in Great Britain there had been movement in the opposite direction – introducing competition into the NHS system had been a key initiative on the part of the new Liberal-Conservative coalition administration.

A prior BBC story talked about how National Health Service patients needing non-emergency care (such as hip and knee replacements!] “are already able to be treated by private hospitals that have agreements in place to carry out the care at NHS cost.”

But “Evidence is emerging that some health managers are rebelling against plans to create greater competition in the NHS,” wrote Nick Triggle. “The BBC has learnt that many English trusts are introducing steps that make it harder for patients to opt to have NHS care done by private hospitals.”

According to Triggle, there are three primary “NHS tactics.” They include promising  “NHS hospitals a certain number of patients, leaving the private sector only what is left over;” minimum waiting times before treatments, taking away the advantage private hospitals have in providing quicker care; and activity caps—placing “limits on the number of patients that can be referred on to private hospitals.”

Somewhat similar tactics are now being employed in the U.S. – such as the Obamacare provision authorizing federal bureaucrats to take away from senior citizens the previous option under Medicare of adding their own money on top of the government payment in order to get insurance less likely to ration.

“It is vitally important for Americans to take warning from foreign rationing,” commented Burke Balch, director of NRLC’s Powell Center for Medical Ethics, “ so that – before it is too late – we act to preserve our ability to choose unrationed healthcare by repealing the Obama Health Care Law.”

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