Now that the Affordable Care Act is working, it is time to adopt national single-payer health care

By Neil H. Buchanan
Justia (Mountain View, Calif.), April 10, 2014

To the surprise of many people, and to the great consternation of Republicans, the Affordable Care Act (ACA, or the dreaded “Obamacare”) failed to fail. Last week, to much fanfare, the Obama Administration announced that the ACA’s enrollment target had been met, which means that the health care law will not collapse from lack of adequate participation.

This was surprising, of course, because of the early software problems that emboldened the ACA’s opponents, and which raised the possibility that technical problems would doom the new law before it could even get started. Now, however, we know that we will proceed to the next stages of our national experiment with a broad expansion of profit-oriented, subsidized health care.

Despite this success, we must now plan to get rid of the ACA, and replace it with something much better. The ACA is inherently incapable of solving the larger long-term problems that our country faces in providing health care to all of our citizens. It was an important step forward, and we should be happy that it did not die a premature death, but we cannot now allow ourselves to believe that the current system is sustainable, or even acceptable.

That is why it is essential to say, clearly and unambiguously, that the United States needs to adopt a system of universal, single-payer national health insurance, as soon as possible. The ACA is as good as it gets, when it comes to basing a health care system on private insurance, and it is simply not good enough. Even as the ACA takes effect, therefore, we need to start planning to make it disappear.

The success of the ACA, and the importance of its component parts

The reason that the ACA was at risk of failing to launch is actually a somewhat complicated story, but the explanation is ultimately about the nature of private insurance. If, against all logic, we decide to continue to run our health care system through competition among private insurers, the system must be designed with several key elements, in order to avoid what economists call a “death spiral.”

Insurers, even those that are not-for-profit companies, need to make sure that they do not ultimately have to pay out more in benefits than they take in from customers’ premiums. This means that insurers will try to separate people into different categories, on the basis of how expensive they are likely to become in the future. Smokers, for example, are treated differently from nonsmokers, for obvious reasons.

It is this simple logic that causes insurers to refuse to insure people with pre-existing conditions. If, for example, you have late-stage cancer, and you want to be covered by a health insurance policy, it would make no sense for the insurer to agree to take you on as a customer. Short of charging you exactly as much as you would have to pay directly for your cancer treatments, the insurer cannot help but lose money on you.

If you fail to disclose to the insurer that you have a late-stage cancer, then the insurer would need a way to protect itself from the economic loss that your deception would create. That is why insurance contracts generally exclude coverage for treatments related to pre-existing conditions. The problem is that insurers, over time, perfected increasingly aggressive ways to define what counts as a pre-existing condition, such that too many people who were insured suddenly found (after paying premiums year in and year out) that their insurers were canceling their coverage because, for example, a cancer patient had failed to disclose that she once had an unrelated illness (such as psoriasis).

Public outrage against such abuses grew, and the result was that even most opponents of President Obama understood that the insurers had overplayed their hands regarding pre-existing conditions. This meant that, when serious discussions began in 2009 regarding health care reform, one of the fundamental elements required of any such plan was that Americans could not be denied coverage due to pre-existing conditions.

This, however, raised a further difficulty. If everyone were to know that they could never be denied insurance coverage for an illness, then there would be no reason to take out insurance in advance of getting sick. This meant that people needed to be required to sign up for insurance in advance. Healthy policyholders, in particular, are an essential part of the economic model of private insurance. Without them, no private company could stay in business for long, because it is the currently healthy people’s premiums that finance the benefits that are paid on behalf of currently sick people.

The so-called mandate, which was the subject of the much discussed NFIB v. Sebelius Supreme Court decision two years ago, was thus an inextricable part of the ACA, because without it, no one would have any reason to sign up for health insurance in a world where they could not later be turned away, no matter how sick (and thus expensive) they became. Without the mandate, the entire insurance system would collapse. Hence, the term “death spiral.”

Finally, in order to allow everyone to become part of the insurance pool, the law had to recognize that some people could not afford to pay for their insurance. They would need to receive subsidies, allowing them to sign up, and thus to make the system nearly universal.

When this was all turned into law, however, it turned out that there was still some possibility that a large number of people would choose to pay the tax (or penalty) that was designed to push them into the insurance pool. Hence, the drama leading up to March 31’s enrollment deadline, which was entirely a matter of seeing whether the insurance pool would be large enough – and include enough currently-healthy people – to avoid the death spiral. Happily, it worked.

The system is inherently wasteful, even when the ACA is running as planned

http://www.pnhp.org/print/news/2014/april/now-that-the-affordable-care-act-is-working-it-is-time-to-adopt-national-single-paye

Sebelius Resigns After Troubles Over Health Site

By MICHAEL D. SHEARAPRIL 10, 2014

WASHINGTON — Kathleen Sebelius, the health and human services secretary, is resigning, ending a stormy five-year tenure marred by the disastrous rollout of President Obama’s signature legislative achievement, the Affordable Care Act.

Mr. Obama accepted Ms. Sebelius’s resignation this week, and on Friday morning, he will nominate Sylvia Mathews Burwell, the director of the Office of Management and Budget, to replace her, officials said.

The departure comes as the Obama administration tries to move beyond its early stumbles in carrying out the law, convince a still-skeptical public of its lasting benefits, and help Democratic incumbents, who face blistering attack ads after supporting the legislation, survive the midterm elections this fall.

Officials said Ms. Sebelius, 65, made the decision to resign and was not forced out. But the frustration at the White House over her performance had become increasingly clear, as administration aides worried that the crippling problems at HealthCare.gov, the website set up to enroll Americans in insurance exchanges, would result in lasting damage to the president’s legacy.

Even last week, as Mr. Obama triumphantly announced that enrollments in the exchanges had exceeded seven million, she did not appear next to him for the news conference in the Rose Garden.

The president is hoping that Ms. Burwell, 48, a Harvard- and Oxford-educated West Virginia native with a background in economic policy, will bring an intense focus and management acumen to the department. The budget office, which she has overseen since April of last year, is deeply involved in developing and carrying out health care policy.

“The president wants to make sure we have a proven manager and relentless implementer in the job over there, which is why he is going to nominate Sylvia,” said Denis R. McDonough, the White House chief of staff.

Last month, Ms. Sebelius approached Mr. Obama and began a series of conversations about her future, Mr. McDonough said. The secretary told the president that the March 31 deadline for sign-ups under the health care law — and rising enrollment numbers — provided an opportunity for change, and that he would be best served by someone who was not the target of so much political ire, Mr. McDonough said.

“What was clear is that she thought that it was time to transition the leadership to somebody else,” he said. “She’s made clear in other comments publicly that she recognizes that she takes a lot of the incoming. She does hope — all of us hope — that we can get beyond the partisan sniping.”

http://www.nytimes.com/2014/04/11/us/politics/sebelius-resigning-as-health-secretary.html?hp&_r=0

Health Care Nightmares

APRIL 10, 2014

When it comes to health reform, Republicans suffer from delusions of disaster. They know, just know, that the Affordable Care Act is doomed to utter failure, so failure is what they see, never mind the facts on the ground.

Thus, on Tuesday, Mitch McConnell, the Senate minority leader, dismissed the push for pay equity as an attempt to “change the subject from the nightmare of Obamacare”; on the same day, the nonpartisan RAND Corporation released a study estimating “a net gain of 9.3 million in the number of American adults with health insurance coverage from September 2013 to mid-March 2014.” Some nightmare. And the overall gain, including children and those who signed up during the late-March enrollment surge, must be considerably larger.

But while Obamacare is looking like anything but a nightmare, there are indeed some nightmarish things happening on the health care front. For it turns out that there’s a startling ugliness of spirit abroad in modern America — and health reform has brought that ugliness out into the open.

Let’s start with the good news about reform, which keeps coming in. First, there was the amazing come-from-behind surge in enrollments. Then there were a series of surveys — from Gallup, the Urban Institute, and RAND — all suggesting large gains in coverage. Taken individually, any one of these indicators might be dismissed as an outlier, but taken together they paint an unmistakable picture of major progress.

But wait: What about all the people who lost their policies thanks to Obamacare? The answer is that this looks more than ever like a relatively small issue hyped by right-wing propaganda. RAND finds that fewer than a million people who previously had individual insurance became uninsured — and many of those transitions, one guesses, had nothing to do with Obamacare. It’s worth noting that, so far, not one of the supposed horror stories touted in Koch-backed anti-reform advertisements has stood up to scrutiny, suggesting that real horror stories are rare.

It will be months before we have a full picture, but it’s clear that the number of uninsured Americans has already dropped significantly — not least in Mr. McConnell’s home state. It appears that around 40 percent of Kentucky’s uninsured population has already gained coverage, and we can expect a lot more people to sign up next year.

http://www.nytimes.com/2014/04/11/opinion/krugman-health-care-nightmares.html?hp&rref=opinion

Budget Chief Is Obama’s Choice as New Health Secretary

By MICHAEL D. SHEARAPRIL 10, 2014

WASHINGTON — Even when Sylvia Mathews Burwell was in her early 30s, friends speculated that she might return to her native Hinton, W.Va., and run for governor someday. After all, she had been a Rhodes scholar, and her mother — who later became mayor of Hinton, population 2,600 — had driven her daughter’s interest in politics.

So far that has not happened, but plenty of other things under two presidents have. On Friday, President Obama is to nominate Ms. Burwell, currently director of the White House Office of Management and Budget, to take over one of the largest and most unwieldy parts of the federal bureaucracy as secretary of health and human services.

If confirmed, Ms. Burwell would replace Kathleen Sebelius, who is resigning.

Ms. Burwell, who was confirmed in a 96-to-0 vote last year to lead the budget office, has spent much of the past year mired in Washington’s fiscal fights, including the standoff that led to a 15-day government shutdown in early October. She also handled health policy as part of her job as Mr. Obama’s budget chief.

At 48, she is on the other side of the digital divide from Ms. Sebelius, 65, who foundered in part because of the vast technical problems with the administration’s health care website overseen by her agency.

A Harvard graduate, Ms. Burwell is a veteran of the Clinton administration, where she served in a variety of positions, including as a deputy to Treasury Secretary Jacob J. Lew when he was President Bill Clinton’s budget director. Before joining the Obama administration, Ms. Burwell was the president of the Walmart Foundation, the charitable organization with ties to Walmart Stores.

http://www.nytimes.com/2014/04/11/us/politics/budget-chief-sylvia-mathews-burwell-is-choice-as-new-health-secretary.html?action=click&contentCollection=Politics&region=Footer&module=MoreInSection&pgtype=article

Our View: Legislators should show leadership, override MaineCare veto

The governor may think that no bill is better than a compromise, but that’s no way to govern.

A bipartisan group of legislators deserves praise for drafting a budget that fills a $30 million shortfall while finding funds to reduce the number of elderly and disabled Mainers waiting for residential and home care services.

This was accomplished without any leadership from Gov. LePage, who petulantly refused to submit a budget this year and has indicated that he would probably veto this one. Lawmakers will have to work without his leadership if they are going to show that responsible government through compromise is still possible in Maine.

Another test, however, will likely come sooner, when the governor’s third veto of a MaineCare expansion bill comes up for an override vote.

The debate has devolved into partisan semantics over whether Maine-Care is “welfare” or “health insurance,” and if adults with incomes near the poverty line are “truly needy.” But the real question is whether lawmakers will defy the governor and act in the best interests of the state.

This bill is also a bipartisan compromise that moves a Republican policy initiative – using managed care to control MaineCare costs – along with a Democratic priority of using federal funds to cover as many as 70,000 Mainers who do not have health insurance.

Expanding MaineCare would attract $1 million a day in federal funds to pay 100 percent of the program until the end of 2016.

At that point the federal share would start to decline, never going below 90 percent. Under the compromise bill, Maine’s participation ends when the full federal support ends, requiring legislative action for the state to continue taking part.

http://www.pressherald.com/opinion/editorials/Our_View__Legislators_should_show_leadership__override_MaineCare_veto_.html

Remove one big barrier to reaching the American dream. Expand Medicaid

By Diane Scalia, Special to the BDN

Posted April 10, 2014, at 5:59 p.m.

Historian James Truslow Adams coined the phrase “American dream” in 1931. He wrote that what attracted immigrants to America was the “dream of being able to grow to fullest development as man and woman, unhampered by the barriers which had slowly been erected in the older civilizations, unrepressed by social orders which had developed for the benefit of classes rather than for the simple human being of any and every class.”

Adams noted that this was a difficult concept for the European upper classes to grasp. Subjected to numerous contextual interpretations over the years, Adam’s concept more recently has been used to stereotype and deprive 70,000 low-income, hard-working Mainers access to health care.

Mental health is a subject often overlooked in the health care discussion. Maine’s mental health system has borne the weight of years of underfunding as the number of uninsured individuals has increased, resulting in needless suffering and increased burdens on Maine’s taxpayers. It threatens the future of our economy.

Half of all Americans will experience the symptoms of a mental illness during the course of their lifetime. Half of those conditions begin by age 14 and three-fourths by age 24. Maine is the most opioid-addicted state and is the only state in New England to not accept Medicaid expansion funding available through the Affordable Care Act.

According to the American Mental Health Counselors Association, there are 20,300 adults, age 18 to 64, who are eligible for mental health and substance abuse services covered by Medicaid expansion funds. Lower-income people are more likely to have mental health issues related to stress and poverty. Serious mental health disorders such as major depression, bipolar disorder, schizophrenia and panic disorder affect one in six uninsured adults with incomes below 138 percent of the poverty level.

Disorders like depression and anxiety caused by stressful life events such as bereavement, illness, homelessness and job loss are equally debilitating, affecting a person’s daily functioning and costing employers millions in absenteeism. Lack of timely care can cause mental health conditions to decline to the point of crisis, requiring more costly emergency and inpatient care funded with revenues from Maine’s general fund. Some individuals end up in the state’s county jails and prison system.

http://bangordailynews.com/2014/04/10/opinion/remove-one-big-barrier-to-reaching-the-american-dream-expand-medicaid/print/

It’s intellectually dishonest to say Medicaid, or any one program, will bankrupt the state

By Matt Dunlap, Special to the BDN

Posted April 10, 2014, at 12:49 p.m.

It had been one of those typically long days in Augusta, a day that had run long into the evening. Patiently, I waited my turn before the Appropriations Committee. At the time, I was the House chair of the fish and wildlife committee and was carrying forward my committee’s unanimous recommendation to supplement the Maine Warden Service’s budget with $250,000 to aid with search and rescue efforts across the state.

When I got to the microphone, the questioning was intense, probing and detailed. Despite a unanimous committee report to support my position, getting the attention of the rest of the Legislature was dependent on what happened right there, right then. After 45 minutes and a few nodding heads, the recommendation was included in the budget.

“At least for now,” the Senate chair cautioned.

In times of economic vigor or in very lean times, the process remains the same. The governor is charged with presenting a balanced budget, and the Legislature can make any number of changes that reflect public input. While it must remain balanced, the number of variations is truly endless.

When the state’s natural resource agency heads spoke at a recent press conference decrying the threat a proposed Medicaid expansion posed to the future of the outdoors, few noted how remarkable their assertions truly were.

Chandler Woodcock, commissioner of the Maine Department of Inland Fisheries and Wildlife, said that the prospect of Medicaid expansion and its possible threat to Maine’s outdoor heritage constitutes “the most important discussion that I’ve been a part of in my lifetime.” Sportsmen may be forgiven their surprise that Medicaid now trumps lack of winter cover for deer, the spruce budworm, a host of diseases, proposed policies restricting hunting activities, and the fragmentation of habitat and access as threats to our outdoor heritage.

The zero-sum game being played here puts forth the premise that the only priorities of any legitimacy to be those of the governor. The Legislature need not bother itself negotiating, because he has it all figured out. According to him, either the Legislature funds natural resource conservation and other state priorities, or it funds the future state share of the expansion of Medicaid and education, but it can’t do them all.

A little history is helpful here. If inquisitive citizens walk through the legislative law library and pick a year — any year — they will get a good idea of how the Legislature works together to address problems and priorities, such as I describe in my experience above. In 1947, for example, the state’s priorities might look a bit familiar to those knowledgeable of the budget-writing process.

Eighty percent of state spending went directly to institutions that worked in health, welfare, education and — this is the state controller’s word — “charity.” Those are numbers not dissimilar to the modern era. But the source of those funds has changed dramatically. In 1947, we had no state sales or income tax. Then, we relied on nearly half of state revenue from two sources — the state property tax and the tax on liquor.

The landscape shifted quickly, but legislators responded just as fast. The sales tax, enacted in 1951 and designed at least in part to replace the state property tax, was the result of a bipartisan committee report from a Republican-dominated legislature.

During the Senate debate on the measure, Sen. James Reid, R-Hallowell, Senate chair of Appropriations and an ardent opponent of increased taxes, nonetheless supported the sales tax measure. He stated, at length, both that he opposed the new sales tax proposal but that he also understood the need for the revenue, despite his and his constituents’ opposition to the new tax.

“(I)n case there is any doubt as to whether I am afraid of any measure, that one of the things that, politically speaking, is the worst thing we could do is to cut down on the public assistance program. … I will vote for the provision in the spirit of harmony and to keep the thing alive.” So he supported it — at least for the moment, much like the Senate chair I worked with more than 50 years later.

http://bangordailynews.com/2014/04/10/opinion/contributors/its-intellectually-dishonest-to-say-medicaid-or-any-one-program-will-bankrupt-the-state/print/

Maine doctors ditch insurance, offer monthly subscriptions for primary care

By Jackie Farwell, BDN Staff

Posted April 11, 2014, at 10:27 a.m.

SOUTH PORTLAND, Maine — Roxanne Pettigrow has no health insurance. But the Gorham woman visits her doctor in South Portland every few weeks, paying $50 up front, once per month for regular checkups, office visits and preventive health screenings — care those lacking health coverage often skip.

With her $600 annual subscription, Pettigrow enjoys hour-long visits and email exchanges with her primary care physician, Dr. Michael Ciampi. The South Portland doctor attracted national media attention a year ago for his decision to stop accepting all forms of health insurance, and he began offering the subscription option in mid-January.

Pettigrow saw Ciampi on the news and became one of his first subscription patients, who number about two dozen.

“Dr. Ciampi never looks at his watch, which I find totally amazing,” Pettigrow said, sitting in an exam room after a recent appointment. “He’s the first doctor I’ve ever seen that doesn’t look at his watch.”

Ciampi’s patients can either pay the monthly subscription — which costs $95 per month for an adult couple and $140 per month for a family — or pay for individual services, based on prices Ciampi posts on the practice’s website. Some patients have health coverage, seeking reimbursement from insurers after the fact. Others find paying Ciampi costs less than accumulating high out-of-pocket costs under their health plan or believe he is worth the better care even if he costs more.

“The $50 a month that I pay, for the services I get, is really unbelieveable,” Pettigrow said. “It really is. I think more people should know what he’s offering because there’s so many of us out there that don’t have health care.”

Pettrigrow said she couldn’t afford the $200-plus per month it would have cost her to buy insurance under the Affordable Care Act. She saves about $75 a month by purchasing her prescriptions through Ciampi’s office, which sells many generic medications to its subscription patients at cost.

His office also provides vaccines at cost, or free for subscription patients. Lab work sent out for processing is offered at the practice’s cost, at a savings of 25 to 75 percent compared with local hospital and commercial labs, Ciampi said.

Included in the subscription are annual physicals; office visits for chronic conditions, illnesses, and injuries; some services related to diagnostic testing, such as EKGs and pregnancy tests; draining of abscesses and some joint injections, among other services.

“Anything that would normally happen in a family doctor’s office, it’s all part of the membership,” Ciampi said. “There are no co-payments, there are no deductibles.”

When patients need to visit a specialist, get an X-ray or MRI, or use other services outside Ciampi’s scope, he does his best to send them to doctors and facilities that offer discounts for paying cash.

Symptom of change

Ciampi’s among a small but growing number of physicians, faced with mountains of insurance forms and packed waiting rooms, who are rejecting the traditional health insurance model.

Independent physicians like him, who don’t work for hospitals with large billing departments to handle paperwork, appear particularly drawn to cutting out the insurance middleman. Freeing themselves of insurance overhead saves both time and money, as doctors can employ fewer people to handle billing. That savings allows them to lower fees, physicians say.

An estimated 1,500 to 3,000 physicians nationally are offering “direct primary care,” according to Garrison Bliss, co-founder of Qliance, a lower-cost concierge medicine firm based in the Seattle area. The umbrella term includes a variety of arrangements under which providers have direct financial arrangements with patients.

http://bangordailynews.com/2014/04/11/health/maine-doctors-ditch-insurance-offer-monthly-subscriptions-for-primary-care/print/

Report: Universal Healthcare Would Be 'Boon' to Businesses

By Bob Herman
Becker's Hospital CFO, April 9, 2014
A new report from nonpartisan advocacy group Public Citizen said a publicly funded healthcare system that guarantees universal coverage would not only reduce healthcare costs — it would also be an economic relief for employers and businesses.
Public Citizen analysts said a single-payer system, commonly referred to as a "Medicare for all" option, could benefit businesses and the general public in three ways:

Universal healthcare would end "job lock." Job lock is a term used for when employees do not want to switch jobs or pursue new ventures out of fear of losing health insurance.
Universal healthcare would likely reduce healthcare costs. Several healthcare researchers and physicians have conducted studies finding that annual savings from moving from a multipayer to a single-payer system could be in the billions, most of which would be gained from less spending on administrative and billing functions.
Universal healthcare would equalize healthcare costs for businesses. Competitive U.S. businesses already pay large sums of money to offer health insurance to their employees, the report stated. Financing a single-payer system would require different taxing mechanisms on businesses, but reports indicate businesses would not likely pay more than they already do — and many may actually pay less. This would especially help small business owners, the report said.

Taylor Lincoln, research director of Public Citizen's Congress Watch division and author of the report, said in a news release the issue is nonpartisan, but it has been absorbed by partisan factions at both ends of the aisle.
"Small businesses have rated the cost of health insurance as their top concern for a quarter century, and large businesses struggle with healthcare obligations that their international competitors do not have to worry about," Mr. Lincoln said. "If it weren't for entrenched partisan alliances, business leaders would have demanded that Congress relieve them of healthcare burdens long ago."
http://www.pnhp.org/print/news/2014/april/report-universal-healthcare-would-be-boon-to-businesses

The Twilight of the British Public Health System?

By Adam Gaffney, M.D.
Dissent, Spring 2014
Less than two years after the fall of Nazi Germany, a bankrupt Britain – reeling from the most destructive war in history and living under conditions of stark austerity – elected to create an extraordinary system of universal health care, the National Health Service (NHS). Aneurin Bevan, the Labour Party minister of health who played a crucial role in its creation, famously remarked that the NHS would “last as long as there are folk left with the faith to fight for it.” Subsequent developments, it seems, have put his challenge to the test.
In 2012 David Cameron’s Conservative-led government passed the Health and Social Care Act, legislation that opens the NHS to privatization like never before. Building on a series of neoliberal health care “reforms” dating back to the Thatcher era and coinciding with the dictates of our age of austerity, Cameron’s law could very well mark the beginning of a slow end for the English NHS (the largely autonomous Scottish NHS has been going in a much different direction). To be clear, the law is not meant to privatize the system entirely; after all, caring for a whole population – including its poor, elderly, and chronically ill – is messy, complex, and frequently unprofitable, and so historically uninteresting from a commercial perspective. Instead, the law will allow – indeed, it will require – the competitive “tendering” of health care services to corporate providers, which can then pick off the profitable parts, bit by bit. Its provisions end the fundamental legal requirement that the secretary of state ensure comprehensive care throughout the country. The law encourages NHS facilities to provide uncovered services for cash, while at the same time reductions in funding force cuts in covered services. The law may even ultimately open new opportunities for fees to be charged at the point of service, in direct contradiction of the service’s founding principles.
The Health and Social Care Act, in other words, will not end the NHS. It will fragment and commercialize it, while the demands of austerity will continue to stretch it thin. At some point, though the NHS will continue to exist, we may no longer be able to recognize it.
I. 1948–1980: 'It Is Not a Charity'
Shortly after the NHS went into effect in 1948, a leaflet was distributed to all homes to explain the function and purpose of the new system:
It will provide you with all medical, dental, and nursing care. Everyone – rich or poor, man, woman or child – can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a charity. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in times of illness.
Though its organizational structure may have been considerably complex, such a simple and straightforward summary spoke to the truly radical – and fundamentally universal – nature of the new service.
Its first few years in action revealed the great, unmet medical needs of the country, with the sudden surge in the use of health care resulting in substantial initial over- spending. This precipitated, in the early 1950s, the introduction of fees for medications, eyeglasses, dentures, and eventually all dental treatment. Still, other care remained free at the point of service, and the NHS’s general structure remained largely intact over the next few decades, protected by strong public support and by a consensus between Labour and Conservatives on the importance of the welfare state. Yet at the same time, the NHS was often starved of resources.
The NHS is frequently touted for its success at keeping the cost of health care low, easily beating not only the United States but also most of its continental peers with respect to efficiency. (In 2008, for instance – after a period of historically high spending – the UK was still only spending $3,129 annually per capita on health care, compared with $3,737 in Germany, $4,079 in Canada, and $7,539 in the United States.) Yet its frugality has time and time again gone too far, and the end of the 1970s – when the United Kingdom was facing anemic growth, marked inflation, and persistent deficits – was one such time.
To read the full article, click here.
http://www.pnhp.org/print/news/2014/april/the-twilight-of-the-british-public-health-system

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Health Care Reform Articles - April 11, 2014