Britain Plans to Decentralize Health Care

[Leopolds Ghost]

http://www.nytimes.com/2010/07/25/world/europe/25britain.html?pagewanted=1&_r=1&th&emc=th

Britain Plans to Decentralize Health Care
By SARAH LYALL
Published: July 24, 2010 P. A11

LONDON — Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate. The new British government’s plan to drastically reshape the socialized health care system would put local physicians like Dr. Marita Koumettou in north London in control of much of the national health budget.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers. The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “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.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. 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.

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So, what's the verdict on this?

[HEyHEY]

1. Bad, this will lead to people not getting proper treatment if they are from a poor region

Which will lead, slowly, to the idea that you show a resident card at a hospital, which will lead to fraud. Eventually this will end up like schools in the sense that more wealthy areas have better schools... ahhh the cycle goes on!

[PDJane]

2. It's a damn stupid idea,

and one that will take years to fix.....or lead to private health care, which will damage the whole idea.


God help the world when the conservatives gather power.

[LeftishBrit]

3. Very dangerous

Interesting that all this was NOT in the Tories' manifesto. Our local Tory candidate's leaflet included the statement that only the Tories could prevent NHS cuts!

If pushed forward, this may prove the government's downfall, as the poll tax was Thatcher's.

Nick Clegg, when will you realize that you are selling your soul, not to mention your party's electoral future, to the devil for short-term trappings of power?

Labour Party leaders, when will you take a break from fighting each other and get serious about attacking the REAL enemy?

[Oregone]

5. Where did this idea originate?

It must of been floating around in policy discussions before the election



Financially, does it specifically benefit any private parties more than the status quo?

[LeftishBrit]

15. This article may be of interest here

http://www.guardian.co.uk/politics/2010/jul/16/austerity-drive-billions-private-sector

And so possibly may this (from a paper usually sympathetic to the likes of Lansley):

http://www.telegraph.co.uk/news/newstopics/mps-expenses/6989408/Andrew-Lansley-bankrolled-by-private-healthcare-provider.html

[Oregone]

4. Ill remain open minded

I thought I read about another decentralized system in a European country that ranks very high...totally slips my mind.

I don't know. Guess we will see. I don't have the energy to put the thought into it all, and I think it depends greatly on implementation.

I'm not sure how absolving a bureaucracy and having doctors become administrators too will result in better overall care at a cheaper price. We shall see.

[Leopolds Ghost]

6. So does this imply conservatives in the US will call for dissolving the wasteful insurance industry?

Which is itself a frankenstein's monster bureaucracy created and fostered by a gov't bent on creating private for-profit fiefdoms, among other large-scale private bureaucracies in this country?

If doctors can administer their own managed care in Britain, then maybe we don't need commoditized health insurance at all in the US.

Let's see some person in the right wing of the Democratic party attack that idea as anti-progressive.

[Oregone]

7. All my comment implies is that I don't know how this will be implemented, and how that'll impact car...

I'm too intellectually lazy to think deep at the moment about what may or may not be for the UK, much less how that parallels to US care & politics

[Leopolds Ghost]

8. I'm just being satirical, not at you. After all, it's Britain's equivalent of insuricare right?

So if they don't need a bureaucracy to manage single-payer health expenditures and can rely on doctor's discretion, then so can we right? meaning we don't need private insurance and managed care bureaucracies that are for profit. Of course, "many people would lose their jobs" in for profit insurance and for-profit businesses are sacred in this country even if they are pseudo-public entities.

We could get rid of half the accountants and lawyers in the US too, if we simplified the tax code... I'm coming around to my family accountant's position on this (he advocates a national sales tax with a dividend check for all Americans in place of low-income tax credit.) Sort of... some of the people that advocate for such things are right-libertarians, but I've heard mumblings on the left too.

[dipsydoodle]

9. I'm here and don't see it making much difference

It will simply change some of the aspects in relation to which our Doctors invoice the NHS in the way they do at present for other services they provide under contract to the NHS.

[mmonk]

10. Britian has decided to go right.

That is because Third Way failed. Hope we don't follow suit.

[LeftishBrit]

11. Britain actually didn't decide on this at all...

Voters moved a bit to the right, but not to this extent. The Tories got a whopping 36% of the vote. Because of our electoral system, and divisions in the opposition, that left them with a plurality (but not majority) of seats. After a lot of haggling between all the parties, Clegg and the LibDems agreed to form a coalition with the Tories. Since then, support for the LibDems has gone down massively in favour of Labour; if there were another election now, some polls suggest that the result might be a Labour minority government. But with our crazy voting system, who knows.

The Tories were super-reassuring about the NHS in their campaign; even I, who hate the Tories, didn't quite believe they'd do this. But part of it is their having the super-disgusting Lansley as Health Secretary.

[mmonk]

12. It is what happens when power changes hand.

It's the same here. It's not necessarily what you want, it's what you got with the election.

[HughBeaumont]

13. Just as we haven't learned from the Reagan/Bewsh debacles, they won't learn from the Thatcher era.

You move right, your country will be destroyed within 3-10 years, how goddamned hard is this???.

And if anyone thinks the right is getting ANY more moderate or centrist as time goes on, they're sadly . . . SADLY mistaken. They'll get worse, greedier and more fanatic until they actually have something that resembles V for Vendetta.

I mean COME on. How many times did you piss on the seat before you listened when mommy told you NOT to do it? Is this REALLY going to take THAT much more time before people get that you cannot give these know-nothings ANY sort of power?

[Lesleymo]

14. I'm always suspicious when I hear about "power in the hands of patients"

Generally, in my experience, that means "here is our mess of a health care system. you figure it out."

[LeftishBrit]

16. You may be interested in this!

http://www.guardian.co.uk/politics/2010/jul/13/andrew-lansley-nhs