How Not to Run a Nationalized Health System

Charges are being leveled at the NHS in the UK for failing to properly care for men with prostate cancer. The issues are money, access to the proper multi-disciplinary health team, and who should pay for treatments.

I raise this issue because it is the kind of thing that will happen if we hearken to the siren song of many USA bioethicists, and formally ration health care. Rationing, in my view, is a polite word for medical discrimination against those who need health care most. Moreover, in a rationed system, disease groups would be fighting each other for pieces of the limited pie. Diseases with strong political advocacy groups behind them would do well, e.g., HIV, breast cancer, etc. Those without the political muscle would probably fare more poorly.

We do have to find ways to bring a much broader swath of people into the health care system in the USA. This is a matter of growing urgency. To avoid rationing, I think it will best be done with a mixed system of private insurance with public backup for catastrophic diseases, and a pool for the hard to insure. We need to permit nationwide underwriting to permit greater spreading of the risk.

What we definitely do not need is a system like the NHS in the UK. What a disaster.