UK National Health Service Resuscitation Implications for the US

September 19, 2024

Prime Minister Keir Starter sets out NHS plans following Darzi report
YouTube
Sep 12, 2024

Lord Darzi today has published his independent report on the state of our NHS. 

As everyone in the country knows, the last government broke the NHS. 

Let me be clear from the outset, what reform does not mean. First, it does not mean abandoning those founding ideals of a public service, publicly funded, free at the point of use – the basic principle of dignity. “When you fall ill, you should never have to worry about the bill.” Second, reform does not mean just putting more money in. Now, of course, even in difficult financial circumstances, a Labor government will always make the investment in our NHS if it is needed. But we have to fix the plumbing before turning on the tap. So, hear me when I say this, no more money without reform.

The last Labor government reformed the NHS to deliver better outcomes for patients and better value for taxpayers. The Conservative government then undid that good work, which only goes to prove, once again, that only a Labor government can reform the NHS.

If we get this right, people can look up and say, “this was the generation that took the NHS from the worst crisis in its history, got it back on its feet, and made it fit for the future. 

Independent Investigation of the National Health Service in England
September 2024
By The Rt Hon. Professor the Lord Ara Darzi of Denham

The National Health Service is in serious trouble.

This report sets out where the NHS stands now, how we arrived at this point, and some of the key remedies.

The NHS budget is not being spent where it should be – too great a share is being spent in hospitals, too little in the community, and productivity is too low.

Conclusions:

The NHS is in critical condition.

Some have suggested that this is primarily a failure of NHS management. They are wrong.

Despite the challenges, the NHS’s vital signs remain strong.

Nothing that I have found draws into question the principles of a health service that is taxpayer funded, free at the point of use, and based on need, not ability to pay.

It has taken more than a decade for the NHS to fall into disrepair so improving it will take time.

There are some important themes that have emerged for how to repair the NHS, which will need to be considered alongside strategies to improve the nation’s health and reforms to social care:

   * Re-engage staff and re-empower patients.
* Lock in the shift of care closer to home by hardwiring financial flows.
* Simplify and innovate care delivery for a neighborhood NHS.
* Drive productivity in hospitals.
* Tilt towards technology.
* Contribute to the nation’s prosperity.
* Reform to make the structure deliver.

The NHS is now an open book. The issues are laid bare for all to see. And from this shared starting point, I look forward to our collective endeavor to turn it around for the people of this country, and to secure its future for generations to come.

 

Comment by: Don McCanne & Jim Kahn

For decades, progressives in the US have been striving to enact and implement an affordable, high-performance system which would provide health care access for everyone. We favored government control over the payment mechanism since private insurers have demonstrated an enduring desire and ever-increasing ability to divert our funds to their private wealth. This diversion would end with publicly funded and administered insurance.

In recent years, progressives have expressed renewed interest in public ownership of health care delivery itself, since entrepreneurial groups (e.g., private equity) entering the provider side have diverted payments for care to their own financial gain. In effect, progressive interest has expanded from universal public insurance as in Canada, to public ownership of the delivery system through a national health service such as the British NHS, valued since post-WWII.

Yet now both Canadians and the British are having problems with their public programs. A critical factor in both nations is ongoing political conflict over the proper role of government versus private sector in health systems. Patients who have great medical needs may find a public system to serve their interests very well by assuring that health care is always affordable. However, individuals with health care costs that are not personally burdensome may prefer to pay less in the taxes that make health care accessible and affordable for everyone.

In all nations and to varying degrees, voters align as either conservatives or progressives. When one of the political interests gains control, as with UK Conservative rule 2010-2024, the NHS suffered budget stasis and privatization. This conflicted with the core NHS goal of ensuring health care for all, regardless of personal financial means. This period of NHS austerity markedly damaged it, as noted in the YouTube and report above.

The lesson for US progressives is that when we propose either single payer or a national health service, it is imperative to create policies and controls that will ensure the maintenance of public programs regardless of the political control of the moment. The ordeal that the British are suffering to recover and repair their health care system demonstrates the consequences of failing this protection. The Conservatives took an electoral drubbing in part due to NHS problems, but the price to patients has been very high.

Recently we discussed a poll commissioned by Bernie Sanders demonstrating that views on public coverage of health care are more consonant across political divides than people realize. Wouldn’t it be amazing if individuals of all political persuasions could join and agree on a system that assures that we all have the health care that we need?

Realistically, we face challenges.

Major party politics in the US have shifted from a conservative-progressive spectrum to a narrower conservative-neoliberal spectrum. This reflects a Democratic understanding that more moderate political positions would be more appealing to voters. An example is the current US presidential election wherein one candidate remains conservative while the other has shifted from a progressive to a neoliberal political position, certainly on health care. We must empower progressive positions, as happened substantially (but insufficiently) under President Biden.

The progressive tax policies needed to power a government-run health care system appear to conflict with the wealth-enabling tax policies of conservatives and neoliberals. Yet, compared with the extremely progressive tax rates following WWII, the progressivity required for single payer is modest. Perhaps there’s a middle ground, whereby the already financially well-situated can continue to grow their wealth, albeit more slowly, while growing health and social cohesion via public insurance.

We should set limits on wealth accumulation, when it is at the expense of social welfare. Do we really need rockets that carry rich people to outer space? Real estate tycoons making fortunes while leaving people living in the streets? Trillionaires? Government and courts controlled by the wealthy?

What is a reasonable social contract? We believe that the wealthy have ample opportunity in this free market world to maintain and build their wealth. It’s time for a robust social contract that ensures that we meet health care and other social needs. Humanity and wealth can co-exist.

From a political perspective, can we mend divisions and work together on policies that serve our collective well-being? We need to be nimble as we pursued the very lofty goal of achieving health care justice for all, as a social consensus, robust across political fluctuations.