Exclusive: An American National Health Service? (Part One of Two)
by ADRIAN MORGAN
March 10, 2009
President Obama recently selected Kathleen Sebelius, Governor of Kansas, to be the Secretary of Health and Human Services. With more than 45 million Americans lacking health insurance, Obama has promised reform of health care.
He chose Nancy-Ann DeParle to be the director of the White House Office for Health Reform. For those already possessing health insurance, Obama pledged during his election campaign to reduce an average family's insurance costs by up to $2,500. For those without health insurance "you will have a choice of new, affordable health insurance options."
It was estimated that $50 to $65 billion would be needed to fund the planned schemes, which included "preventative services" such as cancer screenings. Some of this funding would come from removing earlier tax breaks that had been given to those annually earning a quarter of a million dollars or more. Annually, the United States already spends proportionally twice the amount on healthcare than is spent by other affluent nations. On February 26th this year, Obama promised to make a down payment of $634 billion to achieve these desired reforms over a ten-year period.
Kathleen Sebelius and Nancy-Ann DeParle will have a tough job to make good on Obama's promises, especially as the economy in both the U.S. and globally shows no sign of improving. When Gordon Brown, Britain's unelected prime minister, recently visited Obama there was no public mention of Britain's National Health Service (NHS). The NHS is certainly not a good example for America to follow.
The Birth of the NHS
The NHS was originally brought into existence on July 5, 1948, and was to be funded by universal health insurance ("National Insurance" or NI). The NHS initially aimed to provide free health care at point of delivery, from "cradle to grave," but within only three years it was forced to modify its promises.
The British politician who guided the NHS into existence was a Welsh socialist called Aneurin or "Nye" Bevan (1897 to 1960). The basic principles behind the NHS and the "welfare state" as a whole had been outlined by the economist William Beveridge in 1942, in a report entitled "Social Insurance and Allied Services," now referred to as the Beveridge Report. This report had been commissioned to reassure troops that when war was over, they and their families would have real benefits, rather than the insecurities experienced in the 1930s.
The Labour government of Clement Atlee was elected in 1945, and it immediately began to implement Beveridge's recommendations. There were initial objections from doctors. Nye Bevan famously said that by offering these doctors limited hours on NHS work while keeping their private patients, he had "stuffed their mouths with gold." With the dawn of the NHS, the British government became responsible for all medical planning and implementation, and treatment and medical prescriptions were free for all. As well as covering serious illness, the NHS initially provided free dentistry and optical care.
Before it came into being, planners assumed the NHS would annually cost £110 million to run. In its first year of operation its actual cost was £280 million. By 1950, that cost had risen to £358 million. The government had reserved £2 million for spectacles over the NHS' first nine months but demand was too high. This fund had been exhausted within six weeks.
The runaway costs of the NHS raised fear of its disbandment. In 1950 the Conservatives came to power under Churchill, promising to retain the NHS. By 1951 charges had been introduced. A medical prescription cost a patient one shilling, and dental treatment cost a flat fee of one pound, even though false teeth were issued free of charge. In protest, Aneurin Bevan resigned from government. The NHS now costs British taxpayers an annual fee of £105 billion.
In its 60 years of existence, the NHS has given lackluster provision to its patients. The Simpsons’ 1993 episode where the "Big Book of British Smiles" appears, though satirical, is a sad indictment of the traditional quality of NHS dentistry. In August last year, a report showed that – following government reform – NHS dentists were performing more tooth extractions and fitting more dentures than they had done before Brown's government started meddling.
The NHS now employs 1.3 million people. It is now the third largest employer in the world, following Indian State Railways (1.5 million) and the Chinese Army (2.3 million). Control over regions has been given over to 148 "primary care trusts" and in 2007, a third of these were said to provide "inadequate financial performance." In 2006 there was a financial deficit of £547 million. In January 2009, British members of parliament claimed that many trust managers lacked the necessary skills to implement high-quality care. Back in 2002, 10% of managers admitted falsifying figures to feign compliance with government targets.
Successive British governments have tinkered with the edges of NHS policy, always claiming to be engaging in practical reform. That an organization has been in constant need of reform for its entire six decades of life suggests that it is fundamentally unmanageable. All reforms by all governments, no matter their political persuasion, have ensured that the NHS has become ever more costly and – more worryingly – increasingly unable to provide consistent care in all regions.
Inequality of Provision
Prescriptions for NHS medicines were initially free, but as of April 1, 2009, a standard prescription charge will cost £7.20 ($10.15 at current rates of exchange). Those with illnesses requiring multiple drug prescriptions can now purchase a "prepayment certificate" (PPC). This will cost, as of April, £102.50. As the cost of prescriptions rises, so will the cost of visiting a NHS dentist for a check-up (not including treatment). That will rise to £16.50 on April 1, 2009.
The latest increase of 20 pence to prescription charges, commencing in April, is expected to raise £435 to £437 for the NHS in the financial year ending in April 2010. The increases have been criticized by pharmacists. The British Medical Association has recommended that, in fairness, such charges should be abolished altogether. Some people, such as the elderly, unemployed or those on low income, are exempted from prescription fees.
Everyone in the United Kingdom pays tax from the same tariff, no matter where they live. However, Gordon Brown's Labour Party has tampered with the fundamental structure of the nation and now people in certain regions do not have to pay for prescriptions. Labour introduced "regional parliaments" for Scotland, Wales and Northern Ireland. The Welsh regional assembly voted to scrap all prescription charges, commencing on April 1, 2007. In Northern Ireland, prescriptions will be free by 2010, and by 2011 they will be free for all residents of Scotland. The civilians who live in England will be the only ones who will pay. Worse, their fees will fund the medicines of those living elsewhere. This is far removed from the lofty principles of fairness that were enshrined in the 1942 Beveridge Report or the ideals of Nye Bevan.
There is massive disparity in levels of care provided from region to region. Even the drugs which can be prescribed on the NHS are not available in all regions. This is down to the fact that the 148 regional primary care trusts set their own budget expenditure. Some drugs that can be paid for by one trust are deemed too expensive by another trust. This is what is called in the media the "postcode lottery."
The unfairness of the postcode lottery hit the British press in the last decade. One drug that caused NHS controversy was Herceptin, used to treat breast cancer. This drug was not on a list of "approved" NHS drugs, because despite its effectiveness it was deemed too expensive. As a result, it was available from some of the more affluent NHS trusts but not in others. This unhappy situation forced women suffering from breast cancer to take their primary care trusts (PCT) to court. One such woman was Ann Marie Rogers from Swindon, Wiltshire. She had been originally prescribed Herceptin by her cancer specialist, a decision that was then overruled by her PCT. Her court battle ended in the High Court in 2006, when a judge ruled that her local PCT's approach was "irrational and unlawful." Ms Rogers died last week, aged 57.
In 1999 the Labour government introduced a body called the National Institute for Clinical Excellence (NICE). This body was conceived as an antidote to postcode lottery provision, and was set up to advise the NHS on what drugs were "recommended." In 2005 NICE merged with the Health Development Agency to become the National Institute for Health and Clinical Excellence.
Far from resolving the issue of inequality, NICE's recommendations have been viewed as limiting the nature of medicines available on prescription. For the most part, newer, more expensive drugs do not get NICE approval until evidence has shown without a doubt that they work in most circumstances.
Privacy – What Privacy?
Once upon a time, doctors were expected to keep patient's details confidential. Part of the Hippocratic Oath reads: "Whatever I see or hear, professionally or privately, which ought not to be divulged, I will keep secret and tell no one." In Britain today, such concepts are meaningless. At the end of last year, my own doctor was unashamedly discussing details about me with other people, including those who were total strangers to me. I was only told of this by one of the people present. This informant could be fired by the NHS for "breaching confidentiality" but my confidentiality, of course, means nothing. My doctor was acting under new laws introduced by the Labour Party which allow different agencies to share information, which I shall discuss later.
Firstly, and as a matter of concern to Americans who are considering expanding control over health care, keeping data confidential becomes less possible the larger the system becomes. The larger the bureaucratic body and the more components within that system, the greater the increase of entropy. In the NHS, with 1.3 million people serving an entire population of more than 60 million people, data loss is becoming more and more frequent. With a socialist government that has no respect for personal privacy ultimately controlling such a system, private data is being lost or leaked at an alarming rate.
The scale of the problem began emerging when two computer discs were reported missing on November 8, 2007. These discs were sent by government tax officials, but contained details of 25 million people claiming child benefit, including their National Insurance numbers and bank details. The discs, which included the names, ages and home addresses of every child in the country, had been lost in the post. Earlier warnings about the sensitivity of such information appear to have been ignored.
There then followed revelations about lost NHS data. In December 2007 it was revealed that nine NHS trusts had lost patient records. A minimum of 168,000 patients were affected. 160,000 of these were the names and addresses of patients at City and Hackney Primary Care Trust.
On June 18 2008, a laptop computer was stolen in Scotland. This contained the names, post codes, dates of birth and medical data of more than 20,000 people who had been treated at Colchester University Hospital in southern England.
In the same month, the Scottish Ambulance Service admitted that they had lost data by sending it by courier. 900,000 records, including patients' addresses, names and phone numbers, had been lost.
Again in June 2008, it was revealed that six laptop computers had been stolen from St. George's Hospital in south London. These computers bore the personal data and brief medical summaries of 20,000 patients.
In May 2008 it was revealed that data on 38,000 NHS patients had been lost by a courier firm. The data had been sent from London to the Isle of Wight when it went missing.
In August 2008 it was revealed that in Scotland since 2005 there had been at least 192 instances of patient data being lost. The information only came to light after inquiries were made under the Freedom of Information Act. The information was revealed in the same month that it was disclosed that data on Britain's entire prison population had been lost.
Such breaches of data have also affected those who are employed by the NHS. In September 2008 it was announced that computer discs from four London NHS trusts had gone missing in June of that year. These discs contained the names, personal and employment details of 17,990 NHS staff. The discs had been "lost in the post."
Americans should note that this system entropy – when expanded five times to match the scale of the U.S. population – would get inherently worse when applied across the much larger U.S.
America has a written Constitution which protects personal freedoms in a way that Britain – with no written constitution – sorely lacks. A nationwide system of health control, involving amassing extremely personal data on every man woman and child in every state, could still be open to abuse by unethical individuals and politicians. In Britain, where ethical politicians are an endangered species, the Labour government has introduced numerous new laws in its dozen years in office.
Many of Labour's laws do not exist to protect the individual, only the state. For example, the police can photograph anyone, but it is now illegal to photograph a policeman since February 16, 2009. One of the Labour government's numerous intrusive laws is the Regulation of Investigatory Powers Act 2000 (RIPA for short). This law was introduced to allow agencies to share information, to prevent or expose serious criminal or terrorist activity.
When the RIPA act was first introduced, it allowed surveillance of individuals to be carried out, and information shared between only nine agencies. Now, at least 792 agencies, including the NHS are allowed to spy on individuals and to share information with each other. The RIPA laws are being used by local councils to carry out surveillance on individuals for reasons as petty as dogs fouling footpaths.
And where does this leave the NHS? The National Health Service, originally designed to "reform health care" and make a healthier society, now has trusts that are actually providing guidelines on how to conduct surveillance of individuals. One senior individual in the NHS' "counter-fraud service" was recently reported to have given written permissions for those under him to carry out any action "which might be deemed [covert] surveillance."
The UK government has introduced more laws which allow patient's data to be shared between agencies, such as the Mental Capacity Act 2005, where decisions affecting the treatment or care of people with limited mental skills can involve sharing "confidential" information with other individuals with no connection to the NHS. My doctor was acting under this act, ostensibly on behalf of my mother who was also his patient, when he discussed my details with others.
The latest planned abuse of patients' data by Gordon Brown's government is contained in the proposed "Coroners and Justice Bill." Clause 152 of this act allows confidential medical records to be shared with other government departments and even sold on to private companies, such as insurance businesses. Is this what you want in your country?
The most dramatic aspect of the inequality of healthcare service provision in Britain is found in the issue of healthcare for the elderly who are infirm of mind or body. In Scotland, their regional government has approved free nursing care to people of any age and free personal care for anyone over 65 considered to be in need of such care.
In England, the situation is not the same at all. An elderly individual must possess less than £22,500 in liquid assets before care is completely free. This care is generally paid for by a local council. For those elderly individuals in England who need care at home, similar rules apply. The individual must self-fund until they have only £22,500 left. Means-testing requires that the recipient pays up to a set figure defined by the local authority (usually around £300), and if their care needs exceed that cost, only then will the extra care at home be provided free of charge. This does not apply to those who live in care homes – a person in a care home must be entirely self-funding, though the NHS may then donate £101 per week towards that person's nursing costs.
The British government is aware that there will soon be a large section of the population – comprising former baby boomers – that is elderly. And with the increasing numbers of elderly people will come the diseases of old age. One of the most costly forms of age-related illness is dementia. Last month Alan Johnson, Britain's Health Secretary, announced a "National Dementia Strategy" that would be implemented. This would set up "memory clinics" in every town, where people could be sent by their doctors to be tested for signs of dementia.
Johnson claimed that early diagnosis would mean that people would be able to benefit from early treatments. In theory, that sounds good. However, in practice, it means nothing for a sufferer of dementia. There are many drugs which are proven in many instances to be beneficial for suffers of Alzheimer’s, a common form of dementia.
One of the aspects of Alzheimer’s involves the neurotransmitter acetylcholine being destroyed in the brain's neuron receptors by large amounts by the enzyme acetylcholinesterase. Drugs such as donepizil (Aricept) effectively reduce the actions of this enzyme. Similar medications are rivastigmine (Exelon) and galantamine (Nivaline). Memantine (Ebixa) works on other receptors in the brain, affecting glutamate uptake.
These four drugs, though highly effective in particular forms of dementia, are NOT recommended by NICE for early forms of mild Alzheimer’s. Memantine is not recommended at all by NICE, unless it is used as part of a clinical trial. Therefore, Alan Johnson's claim that early recognition of dementia in "memory clinics" will enable people to receive "treatment" is therefore unrealistic. NICE will review its decisions in September 2009.
I have a special interest in Alzheimer’s. My mother was diagnosed with the condition in June 1998. She finally died on February 12, 2009 after a short illness. For more than a decade I looked after her myself at her home, with help from visiting care assistants. I would like to say that I received help and support from the NHS. That is not the case. There have been some individuals from the NHS who have been good, but most have been officious, arrogant and sexist – i.e. prejudiced against male caregivers. 10 years ago, NHS officials even tried to have me evicted from the family home.
On Thursday in Part Two, the conclusion of this article, I will recount what my mother and I experienced directly at the hands of the NHS. It is a story that I promise you will find hard to believe, but it is a cautionary tale that anyone concerned with reforming U.S. health care should read. Additionally I will describe the policies which allow Muslims within the NHS to have their religious beliefs respected, while NHS rules simultaneously discriminate against Christians.
FamilySecurityMatters.org Contributing Editor Adrian Morgan is a British-based writer and artist who has written for Western Resistance since its inception. He also writes for Spero News. He has previously contributed to various publications, including the Guardian and New Scientist and is a former Fellow of the Royal Anthropological Society. Feedback: firstname.lastname@example.org