Repairing the Healthcare System: Britain Plans to Decentralize Health Care:When Will We Ever Learn?

Stanley Feld M.D.,FACP,MACE

Winston Church was right when he said, “You can always count on Americans to do the right thing—after they’ve tried everything else.”

Dr. Don Berwick, our new Director of CMS has touted Britain's National Health Service, as the ultimate role model. The British government has declared the National Health Service a fiscal failure.

Donald Berwick was appointed Director of the Center for Medicare and Medicaid Services during the Senate’s recess July 4th. President Obama avoided a confirmation hearing. The American people did not have the opportunity to hear Dr. Berwick’s philosophy and his plans for Medicare.

Dr. Berwick has some good ideas and some very bad ideas. President Obama’s ideas are not about repairing the healthcare system. His ideas are about central government control of the healthcare system.

President Obama and Dr. Berwick are portraying physicians and patients as the villains. It is easy to blame the physicians and the patients because both have some blame in the dysfunction of the healthcare system.

The villains are the healthcare insurance industry and malpractice reform.

Britain’s new coalition government has proposed a reorganization of its National Health Service

After 62 years, the British government’s goal is to decentralize its healthcare system. Unfortunately, Britain is making another complicated mistake.

Britain's National Health Service has continually changed over the 62 years. Various British administrations have searched for the formula to deliver high quality care at an affordable price. Britain has nevertheless experienced increasing costs and demand as quality and access to care has decreased.

What is missing from the British system?

The government believes that the people are not smart enough or responsible enough to figure out how to take care of themselves. The government is wrong. All government has to do is make the right rules, empower consumers with money, level the playing field among stakeholders and get out of the way.

We have learned that building bigger and bigger bureaucracies never solves social problems. They make the problems more complicated and more costly to fix.

The British government wants to shift control of the $160 billion annual health budget from its centralized bureaucracy to general practitioners at the local level. Under the plan, $100 billion to $125 billion a year would be provided to general practitioners to make medical decisions for their patients. The general practitioners will be responsible for buying hospital and medical services, medical equipment and pharmaceuticals for their patients.

General practitioners would be transformed into medical contractors. America made that mistake with the gatekeeper concept in the 1980s and 1990s. General practitioners would presumably keep the money not spent on their patients. This would provide general practitioners with the motivation the keep costs down. The government would save $35 billion dollars. General practitioners would make more money. Patients would be shafted even more than they are now.

The N.H.S plans to shifted responsibility for deciding on care needed from central control to the general practitioners. At the same time, the government is decreasing the resources available and restricting their use. It cannot work!!

The British government finally understands the need to eliminate the inefficient central bureaucracies. In the United States, we are going in the opposite direction under Obamacare.

“The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. 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.”

I believe this is a pipe dream. It will be replaced by other inefficient layers of management.

“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.”

President Obama and Dr. Don Berwick have 160 new agencies to administer healthcare care reform for Americans. Will it work? No!

“The British government has promised that the new plan will not affect patient care and that the health care budget will not be cut. But some experts say those assertions are misleading.” “History shows clearly that quality will suffer as a consequence.”

Where is patients’ responsibility for their care and health in the new British healthcare system?

The only thing that will save Britain is to put consumers in control of their own healthcare dollars and medical care. Consumer driven healthcare using ideal medical savings account is the answer. Let patients be their own police officers.

WHEN WILL WE EVER LEARN?