Galen Institute Commentary Alert

Britain Moves toward Doctor-Patient Control

National Review Online
By Grace-Marie Turner
July 27, 2010

Britain’s new coalition government is proposing a major transformation of its socialized health-care system to give doctors much more authority over decisions involving their patients’ care.

This most entrenched of government-run health systems is recognizing the importance of the doctor-patient relationship just as the United States is taking a sharp left turn toward more centralized government control over health care.

Is the world turning upside down?

The New York Times examines the plan “to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level,” calling it “the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.”

Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

Britain is trying to find a way to respond to the growing wave of consumerism sweeping Europe. Better-informed patients are demanding more control over health-care decisions and are increasingly fighting the authority of large, centralized bureaucracies to make decisions about their care.

Not surprisingly, the British government’s proposal is facing strong opposition from entrenched interests. “Many critics . . . doubt that general practitioners are the right people to decide how the health care budget should be spent,” the Times reports. One of these critics is David Furness of the Social Market Foundation, a London think tank. He calculates that the plan would make every general practitioner (GP) in London responsible for a $3.4 million budget. GPs would band together in regional consortia to buy services from hospitals and other providers.

“It’s like getting your waiter to manage a restaurant,” Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”

He disparages doctors at his peril.

Under the proposed plan, hospitals would escape some of the bureaucratic micromanagement that binds them in red tape. They would become “foundation trusts” with much more independence, somewhat like charter schools in the U.S.

British health secretary Andrew Lansley is straightforward about the rationale for his proposal. His government’s white paper explains: “Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

Opponents are sounding alarms that the changes mean the terminally ill won’t get adequate care and that waiting times will be even longer for surgeries like knee and hip replacements.

There always is a risk with any government rationing system that more care will be provided to the healthy majority of patients who vote, leaving less for those who are older and sicker. But is it safer to give the relevant decision-making authority to doctors, or to bureaucrats and politicians? If there is less money for administrators, there will be more money for patients.

The labor unions and the bureaucrats are, of course, apoplectic about the loss of some of the bureaucratic jobs that have swallowed up most of the money from a tripling of the NHS budget since 1998.

Robin Durie, a senior lecturer in politics at the University of Exeter, wondered how the government would be able to “give patients more choice — a promise that seems to require a degree of administrative oversight — while cutting so many managers from the system?”

You can’t make this up. Britain’s coalition government is getting it right. Bureaucrats don’t deliver care; doctors do. Sixty-two years after the founding of the NHS, the British government recognizes it has no choice but to give doctors and patients more authority over health-care decisions.

The complex plan — which would affect only England — will need legislative approval to be enacted, but we should expect some version of it to pass, because it reflects a growing awakening in Europe to the importance of consumer control and choice.

For example, during a conference in Paris in late May, organized by the European Union of Private Hospitals, there was broad agreement about the value of consumer choice, competition, and portability in health care, and about the essential role that private providers play in European health care. More than 400 people attended the conference, including members of the European Union parliament, former health ministers, and many corporate CEOs.

John Bowis, former U.K. minister of health, spoke about the importance of allowing “patients to be partners in managing their care,” and stressed that “information is key to empowering patients.”

Throughout Europe, a network of private hospitals is growing. Government officials say private hospitals serve as a safety valve for public health systems; they allow people to escape waiting lines that would be even longer without their services. Many believe the private hospitals make public hospitals better by providing competition. How tragic, then, that the recently passed health-overhaul law in the U.S. effectively prohibits new physician-owned private hospitals from opening. Physician Hospitals of America has rightly filed suit, challenging these provisions.

Clearly, Europeans have come to these conclusions based upon long experience with government-controlled, bureaucratically run health systems. Such systems don’t work, especially with something as personal as health care. And yet, the U.S. has adopted “reforms” that will reduce genuine competition and put more control over health-care decisions in the hands of government bureaucrats.

We should also note that President Obama has bypassed the constitutionally required Senate confirmation process to put Dr. Don Berwick — who is in love with Britain’s socialized health-care system — in charge of implementing key parts of his health-overhaul law. When Berwick appears at some point before a congressional committee, members might want to ask him what he thinks about Britain’s move to give doctors and patients, not bureaucrats, more authority over health-care decisions.

As Rep. Paul Ryan (R., Wis.) said at a recent Galen Institute conference, Obamacare “will not stand.” The political system, the courts, or the American people — and probably all three — will get us back on the right path.