The National Health Service is like a deity in Britain. Or so we are told. Irish actor and director, Graham Linehan – a very funny man – has taken to defending the NHS by saying that American criticisms of it are “like if you criticize your parents. You can do it – but if anyone else criticized them you’d murder them.” That’s not going to keep life expectancies up. The Economist, for its part, offers up the plea “God save the NHS.” So much for the Queen, apparently.
There is something distinctly off-putting in this worshipful attitude. The NHS is not the English Bill of Rights, or the First Amendment. It is not a statement of eternal truths. It is a bureaucratic organization intended to serve a particular purpose. If it does not serve that purpose well, then it should be changed. The outraged responses to American – and British – criticisms of the NHS have a calculated political purpose: to reject the very thought that the government should not be responsible for running the entire health care system.
But the criticisms keep on coming. Yesterday saw the leaking of a report by McKinsey, the consulting firm. McKinsey had been asked to advise the NHS on how it could save 20 billion pounds – about 35 billion dollars – by 2013/14. That’s only three budget cycles away, so saving that kind of money is a tough target. McKinsey’s conclusion: “NHS hospitals in England are rife with waste and inefficiency,” with low staff productivity, too many admissions, wasteful procurement, and heavy debt burdens thanks to bad financing.
The problem with financing comes as no surprise: the British armed forces suffer from a similar problem. What is really surprising is where the cuts in the NHS will come. According to McKinsey, the NHS needs to lose 137,000 jobs, or 10% of its workforce. While 30,000 administrators will go, so will over 100,000 medical professionals. Medical school places would be reduced to avoid an “oversupply” of doctors, and older doctors and nurses will be encouraged to retire. Acute care will be the hardest hit: McKinsey projects it will lose 38% of its budget. There would be further savings if procedures with “limited clinical benefit” – such as tonsillectomies, varicose vein removal and some hysterectomies – were decommissioned.
The government, to put it politely, has not given McKinsey’s proposals a terribly enthusiastic reception. But dilemmas like this one are what you get when you let the government run the entire health care system: either you pay for everything, at the cost of untold inefficiencies and an eternal struggle to balance the books, or you decide that things would be much more affordable if you let some more doctors go and cut back on the tonsillectomies. Not an enviable choice. Britain may treat the NHS as a deity, but the McKinsey report reveals, yet again, why single-payer systems are a false idol.